And the worst-case: $19 billion goes down the drain.
The medical industry is hoping for the first outcome, even while some fear the second, as the Health and Human Services Department tries to get hundreds of thousands of doctors to quit using paper files and join the digital age.
The money for the massive undertaking is in the economic stimulus bill that President Barack Obama signed into law last month.
"We need to get this right," said Dr. David Kibbe, a senior adviser at the American Academy of Family Physicians. "Adoption of information technology for its own sake really is not the end game."
The end game, Kibbe and others say, is for doctors' offices and hospitals to be able to easily share patient information, something the vast majority can't do today. That would cut down on mistaken and unnecessary procedures and give doctors faster access to more accurate information about patients' medical histories and drug regimens.
The government's history of undertaking major technological upgrades isn't entirely encouraging.
The FBI spent four years and $170 million trying to modernize its paper-based case system, only to kill the project in 2005. Before that, the Federal Aviation Administration wasted more than $1 billion trying to overhaul the air traffic control system.
For advocates of the health technology transformation, the biggest fear is that the money could pay just for making paper records electronic, without giving doctors and hospitals much greater ability to connect.
"It's not going to improve the decisions that either providers of care or patients make unless we get that information to move from the existing stovepipes," said Zoe Baird, president of the Markle Foundation, which works to improve health care and national security.
The U.S. lags behind many other countries in adoption of electronic health records. A report in the New England Journal of Medicine, based on surveys from 2007 and 2008, found that 4 percent of physicians had extensive, fully functional electronic records systems, while 13 percent had more basic systems.
Typically, many systems aren't connected to other physicians or hospitals. Dozens of vendors compete to sell proprietary systems that often cannot communicate with each other. Installation costs are prohibitively expensive for some doctors, particularly those in small practices.
Lawmakers and the Obama administration say they are aware of those problems and tried to write the stimulus legislation to address them. The bill envisions new standards to drive development of systems that are better able to communicate, and requires doctors and hospitals to show they're going to be able to put those systems to "meaningful use."
Computerizing records will "save money, improve the quality of care for patients and make our health care system more efficient," HHS spokesman Nick Papas said. "We will move quickly and carefully to help implement this technology."
But important details are missing from the legislation. A health secretary is not yet on the job, and other important officials are not in place. Just on Friday, the administration named the official who will serve as national coordinator for health information technology - Dr. David Blumenthal, a former Harvard Medical School professor who advised Obama during the presidential campaign and once worked for Sen. Ted Kennedy, D-Mass. Kennedy is chairman of the Senate Health, Education, Labor and Pensions Committee.
The stimulus bill specifies that $17 billion is to be spent in incentives through Medicare and Medicaid to nudge doctors and hospitals toward electronic record-keeping beginning in 2011. In 2015, financial penalties will start for doctors and hospitals if they haven't done so.
What systems will be deemed acceptable? How will doctors and hospitals be able to show they will put such systems to meaningful use? Those questions remain largely unanswered.
Preliminary technological standards are due at the end of this year. That doesn't give doctors, hospitals or technology companies much time to get systems up and running by 2011.
The bill also contains $2 billion for items such as health technology grants, training initiatives and state programs. The uncertainty surrounding this money has touched off heavy lobbying from interest groups hoping for a piece.
"The devils are in the details and we don't know the details," said Janet Marchibroda, head of the eHealth Initiative, a nonprofit that advocates for health improvements through technology.
Still, many health care professionals are optimistic about the prospects for a more connected health care system ahead.
"It will take time to get there," said Tom Romeo, IBM's vice president for government health care. "But everything's in place to really make a huge jump forward now like it never has been before."